A delayed primary esophago-esophagostomy of a case of long-gap esophageal atresia without tracheoesophageal fistula was performed in success with three months' intermittent periodic bougienage of the upper pouch via mouth as well as the lower esophagus through Janeway gastrostomy. Meanwhile, an effective continuous sump suction from the upper pouch seemed to be a critical part of the patient management. The extra length of esophagus for primary anastomosis could be achieved by a circular myotomy. Stricture at the myotomy site, found 4 months later, was treated with periodic pneumatic baloon dilations only with temporary symptomatic reliefs. After 4 months' trials, operative esophagoplasty was performed successfuly. A careful follow-up schedule for the myotomy site would be required for early detection of stricture. The previous neonatal patient is currently 8 years old, healthy schoolboy, and has a normal barium swallow without stricture or gastroesophageal reflux.
